Appropriate Nurse Staffing levels can make a significant increase in facility payment reimbursement, especially with the Skilled Nursing Facilities Prospective Payment System (SNF PPS) slated to launch in early 2019. All of the measures currently in use by CMS are positively affected by increased Nurse staffing ratios. They include such measures as the percent of residents with new or worsened pressure ulcers, administration of seasonal flu vaccine, falls, drug regimen review, care planning and mobility for patients on ventilator support.

In a document prepared for the American Nurses Association (Nursing World, 2015), Avalere Health LLC, notes, “Nurse staffing systems are often antiquated and inflexible. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors. Factors that influence nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; and availability of or proximity to technological support or other resources.”

According to the ANA, appropriate nurse staffing can:
• Reduce medical and medication errors
• Decrease patient mortality, hospitable admissions and length of stay
• Decrease patient falls, pressure ulcers, infections and other complications related to hospitalization
• Decrease patient care costs by reducing unplanned hospital admissions
• Promote better nurse safety, retention and job satisfaction.

In acute care hospitals, McHugh et. al. (Health Affairs, 2013) reported data indicates that those hospitals that use higher levels of RN staffing to ensure manageable workload have lower readmission rates. When staffing is inadequate, care processes such as discharge preparation, care coordination and patient education are hampered due to inadequate time and resources. Nurses are less able to monitor for complications, especially those subtle signs in the early stages of a problem such as an infection, which may result in readmission.

One study by Cimiotti et.al. (American Journal of Infection Control, 2012) found that healthcare-associated urinary tract and surgical site infections were higher in those hospitals in which nurses cared for more patients. Data from this study showed that when a nurse’s workload was increased by a single patient above the average, both urinary tract and surgical site infections increased.

Making the case for better nurse staffing requires good data on the benefits in quality and costs. Unnecessary hospital readmissions are more expensive to the health care system, but they also result in lost revenue for the skilled nursing facility. In addition to the loss of direct revenue, there is a high potential for lost revenue from incentive payments.

Is your facility able to saff up or down based on your frequent fluctuations in acuity or seasonality of your Nurse’s vacation requests? IntelyCare’s On-Demand Staffing platform has some great options for facilities needing the flexibility to adjust their Nurse staffing in as little as 4 hours prior to shift start.

References:
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/LTCH-Quality-Reporting-Measures-Information.html
http://www.nursingworld.org/DocumentVault/NursingPractice/Executive-Summary.pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4315496/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3509207/

Chris Caulfield (RN, NP-C), is the Co-founder and Chief Nursing Officer of Intelycare which the fastest growing Per-Diem Nurse Staffing organization in the US. IntelyCare is a technological enhanced platform that was founded in 2016 and now has over over 3,000 IntelyPros (RN, LPN, and CNA employees) serving over 150 healthcare facilities throughout the northeastern US.

Prior to founding IntelyCare, Chris’ past Healthcare experience includes Long Term Care Nursing, Nursing Informatics, Labor Relations, Case Management, and a Urgent Care Nurse Practitioner.